
<h2>Create Supplier</h2>
<hr>


<div id="infoMessage"><?php echo $message;?></div>
<div class="span12">
<div class="span4"> &nbsp;</div>
<div class="span5">
<?php	 echo form_open("admin/diagnosis/edit_supplier/$sid ");?>
     <table width="100%" align="center" class="table-condensed">  
        <tr> <td ><b>  Supplier Name: </b></td>
            <td><?php echo form_input($supplier_name);?><?php echo form_input($id);?></td>
        </tr>  

      <tr> 
     	  <td> <b>Mobile Number:</b> </td>
    	  <td><?php echo form_input($mobile);?></td>
     </tr>  
 <tr> 
     	  <td> <b>Landline Number:</b> </td>
    	  <td><?php echo form_input($landline);?></td>
     </tr>  	 
      <tr> 
     	  <td> <b>Email Address:</b> </td>
    	  <td><?php echo form_input($email);?></td>
     </tr>   
      <tr> 
     	  <td> <b>Address:</b> </td>
    	  <td>  <?php echo form_textarea($address, '', 'style="height : 50px;"');?></td>
     </tr>   
      
        
<tr><td>&nbsp;&nbsp;&nbsp;</td> <td>&nbsp;</td></tr>
</table>
<p align="center"><?php echo form_submit('submit', 'Update Supplier', 'class="btn btn-info"');?></p>
<?php echo form_close();?>
</div>
</div>